Foreskins: leave them alone.

Continuing with only clinically indicated circumcisions, I occasionally used the foreskin as a flap to cover degloved digits (anchoring the hand to the thigh with sutures and strapping it for a few days) and also as a free skin graft and in hypospadias repair. The foreskin was used most dramatically in scrotal elephantiasis. Here the mass is lifted by assistants and a tourniquet is wound several times around its base. This mass, often several kilos in weight, is removed (usually falling on the floor!). After haemostasis, the tourniquet is released and the testes pushed under the groin skin. The penis, which for years has been hidden in a tunnel, is revealed at last. The attached and usually thin foreskin is pushed back over the penis. This will only partially cover it, so flaps from the abdomen or groin are needed.